Telemedicine Use During the Pandemic Less Frequently Used for Preventive Care

Over the course of the COVID-19 pandemic, use of telemedicine declined after its initial early increase, but continued to most commonly be used for established patients and the delivery of psychiatric or behavioral treatments.

A study in JAMA Health Forum analyzed data from the IQVIA National Disease and Therapeutic Index regarding outpatient care in the United States between January 1, 2018, and December 31, 2020. The researchers sought to understand the changes in ambulatory care through characterizing the most common conditions or diagnoses for office-based and telemedicine care and by classifying each visit as a short-term, long-term, or preventive issue.

“While the COVID-19 pandemic has driven increases in the use of telemedicine, much less is known about how the pandemic has changed the clinical content of ambulatory care,” the authors explained.

While the volume of office-based care was stable until the fourth quarter of 2019, it began to dip in the first quarter of 2020 before declining sharply from a mean of 84.0 million visits per month in the first quarter to 49.3 million visits in the second quarter. Visits increased slightly to 60 million in the third and fourth quarters.

Meanwhile, telemedicine visits saw the opposite trend: they stayed stable through the first quarter of 2020 and increased sharply in the second quarter, before declining a bit in the third and fourth quarters of 2020.

Preventive care had greater declines between the second and fourth quarters of 2020 than long-term or short-term care for both office-based and telemedicine visits.

• In 2018/2019, short-term care accounted for 22.2% of office-based care and 24% of telemedicine visits, which increased slightly to 23.5a% and 26.8%, respectively, in 2020.
• In 2018/2019, long-term care accounted for 64.5% of office-based visits and 71.6% of telemedicine visits in 2018/2019, which decreased for office-based visits to 60% and increased for telemedicine visits to 77.1% in 2020.
• Preventive care increased in the proportion of office-based visits from 22.5% in 2018/2019 to 24% in 2020 but decreased in the proportion of telemedicine visits from 5.3% to 2.6%.

The researchers also identified the most common diagnoses managed during 2020. There were 9 that were the among the 15 most common for both office-based and telemedicine care: hypertension, hyperlipidemia, diabetes, depression, conduct disorder, respiratory infection, anxiety, asthma, and urinary tract infection.

Psychiatric and behavioral conditions were more common in the telemedicine diagnoses, while preventive care was more common in the office-based diagnoses. The researchers highlighted the noteworthiness that telemedicine was often used for psychiatric and behavioral conditions, adding that other studies have noted the increase in pandemic-related mental health conditions.

While specialty care, primary care, and surgical care all saw increases in telemedicine between +700% and +3,364%, office-based visits decreased enough for all of them to have an overall decrease in care.

It remains unclear if the shift to telemedicine will remain after the pandemic given that many of the historical barriers to telemedicine adoption remain and modifications at the federal and state level may not be permanent.

“Interestingly, despite the large decrease in office-based visits and increased telemedicine delivery early during the COVID-19 pandemic, we noted a rebound in in-person visits during the third and fourth quarters of 2020,” the authors concluded. “This rebound may have been associated with a relaxation of clinical policies that were previously restricting such care, pent-up demand on the part of patients, and greater comfort on the part of clinicians and patients in managing face-to-face workflows safely.”